Health Assessment Form

Awaken...Discover where you are and where you want to be!
Describe where you are in your health now... (Weight, sleep, stress, energy, etc.)*
Describe where you would like to be in your health.*
Describe WHY you are interested in getting healthy. (What is your main motivation... relationships, activities, how you feel, etc.)*
When was the last time you remember feeling your best in your health or being at your ideal weight or size? (If that is part of your goal)*

Motion
How would you rate your energy level? (on a scale of 1-10, 10 being highest energy)*
How many times a week do you exercise?
What physical activities do you participate in?
Are there things you cant do that you would like to be able to do?

Stress
How would you rate your stress level? (on a scale of 1-10. 10 being the highest stress)*
What do you to for work?
How much do you enjoy what you do?
Are there other stressors in your life?

Surroundings
How healthy would you rate your surroundings? (on a scale of 1-10, 1 being least healthy)
Do you keep junk food in the house, have craving, etc?
Do you have healthy & active friends and supportive family? Is there anyone in your life who would like to get healthy with you?
Should be Empty:

Awaken...Discover where you are and where you want to be!